THE ENEMY WITHIN
AN OLD KILLER IS GAINING NEW GROUND. HERE’ S HOW YOU CAN LEVERAGE THE LATEST SCIENCE TO BOLSTER YOUR DEFENCE S AGAINST THE FIVE MOST COMMON CANCERS FOR MEN
An old killer is gaining new ground. Leverage the latest science to your advantage.
FOR POLICE OFFICER MOSES KHESWA , HIS FIRST SIGN OF COLORECTAL CANCER AT AGE 46 WAS BLOOD IN THE TOILET. FOR RADIO ANNOUNCER MARK PILGRIM, DIAGNOSED WITH TESTICULAR CANCER AT 19, IT WAS A SWOLLEN TESTICLE THAT LOOKED OUT OF WHACK. FOR MONTHS, AT 32, BRETT SIMPSON WROTE OFF HIS SKIN CANCER AS A COLD SORE THAT WOULDN’T HEAL . WAYNE HERWITCH, 47-YEAR- OLD SPORTS COACH, HAD NO SYMPTOMS OF PROSTATE CANCER; A ROUTINE PS A BLOOD TEST ALERTED HIM AND HIS DOCTOR THAT SOMETHING WAS WRONG, POSSIBLY CANCER–AND FURTHER TESTS PROVED IT.
TYPES OF CANCER
While there are more than 200 varieties of cancer, according to the Cancer Association of South Africa (CANSA), the top five among South African men in order of frequency are skin cancer; prostate cancer; colorectal cancer; lung cancer; and cancer of unknown origin. (This last is a grab bag of cancers that have spread, but doctors can’t tell where they originated.) But when it comes to younger men – between the ages of 19 and 35, say – testicular cancer is number one on the list.
WHAT’S YOUR RISK OF GETTING CANCER?
According to the SA National Cancer Registry (2012), a man has a one in seven lifetime risk for all cancers.
CANCER RISK FACTORS
Your chances of getting cancer depend on a variety of issues; including the type of cancer, your age, family history and race, and a host of lifestyle factors – such as whether or not you smoke, drink alcohol, consume loads of red or processed meat, avoid fruits and veggies, or never get off the couch (let alone crack a sweat).
While we’re on the subject, your weight – if you have too much, and whether it accumulates around your belly – affects the likelihood you’ll get certain types of cancer, including prostate and colorectal.
Enjoying the outdoors without adequate sun protection can set you up for skin cancers. Unsafe sex or sharing needles can increase your risk of contracting viruses
such as HIV, HPV and hepatitis, which in turn leave you vulnerable to various cancers, including anal, penile and liver, and Kaposi’s sarcoma (a type of skin cancer prevalent among AIDs sufferers).
Cape Town gastroenterologist Eduan Deetlefs explains: “When it comes to cancer, there are many major risks you can’t control, such as family history and age. But there are others you can.”
These include your diet, how much and how regularly you exercise, and your exposure to carcinogen sources such as smoking, alcohol, sun, chemicals, and x-rays. Vaccinating against hepatitis and HPV and practising safe sex can also reduce your risk for certain cancers.
DISBELIEF, SHOCK AND FEAR – HOW WOULD YOU REACT?
Most men are not prepared for a cancer diagnosis. Their initial response is surprise (if not complete disbelief), followed by fear.
Wayne Herwitch – whose partner, Lucy Balona, is Head of Marketing & Communications for CANSA – explains: “You don’t think it’s going to hit you; and when it does, it’s a shock. I had the sense I was just too young to get it.”
Despite being well-educated, health-oriented, and having a wife who is a professional cancer educator, Wayne believed he was invincible. Because of this misplaced confidence, he delayed his annual PSA blood test. He had tested four years before, and passed with flying colours; he was gobsmacked when his PSA and follow-up showed prostate cancer.
For Marc Curlewis, who got his testicular cancer diagnosis days before turning 30, his response was disbelief. His surgery – including the removal of a testicle – happened so quickly, he was forced to cope with his diagnosis at light speed. But seven years later, he’s cancer-free, married, and looking forward to having kids.
IGNORING SYMPTOMS: IT’S WHAT GUYS DO
Gauteng urologist Dr Bradley Wood says men are notorious for ignoring classic cancer symptoms – because they’re in denial, or ignorant, or scared, or just preoccupied with other stuff. Stats suggest that guys will ignore a lump or a swollen testicle for two months or more before seeing a doctor. This delay may allow a fast-growing malignancy such as testicular cancer to spread to other organs, making it tough or even impossible to treat.
Brett Simpson was an avid surfer and outdoorsman when he discovered a lesion on his lower lip. Misdiagnosing it as a cold sore or fever blister, Brett let it fester for months. When it became painful to eat, Brett’s girlfriend insisted he see a doc, who diagnosed an aggressive squamous cell carcinoma (SCC), a kind of skin cancer. Within 48 hours, Brett underwent surgery to remove part of his lip.
Because of the delay, the cancer had spread to Brett’s lymph nodes, and he needed invasive surgery and radiation. He took months to recover; but 10 years later, he’s alive, and now coaches others who have cancer.
Brett’s cancer ‘transformed’ him, he explains. No longer ‘a cowboy’ with his health, he prioritises his physical and spiritual well-being, doing yoga, meditation, and long-distance running. He’s completed multiple Comrades, along with the Puffer and an Ironman. He still surfs and kiteboards – but these days, he’s vigilant about sun protection.
Along with ignoring cancer symptoms, many guys don’t do self-checks – or take advantage of routine screening, which is readily available through their doctor or clinic, and sometimes free, through CANSA.
For some cancers (colorectal and prostate, for example), when you experience symptoms such as pain or urinary problems, the cancer may already be advanced and have spread to other organs. Routine screening means you spot a cancer before symptoms occur; and most importantly, you can treat it before it enlarges or spreads.
WHY DO SOUTH AFRICAN MEN GET THE CANCERS THEY DO?
South Africa has the second-highest rate of occurrence of skin cancer in the world, after Australia. Cape Town dermatologist Dr Dagmar Whitaker explains that SA’s sky-high levels are because of exceptional UV concentrations in the southern hemisphere; and
because South Africans spend so much time outdoors, often unprotected.
Skin cancer is routinely traced back to repeated childhood exposure, which then continues throughout adult life. As Dr Whitaker explains, the immune system can deal with errant cells for years; but eventually it weakens, and cancer grows. And while light skin is more prone to cancer, those with darker skin are at risk too.
Colorectal and prostate cancer risk is associated with both lifestyle and genetic factors. Race plays a role too: both white and coloured men have higher rates than black men. But both cancers are associated with being overweight, lack of exercise, high red-meat consumption, and veggie-poor diets. Traditional African diets that are high in fibre are thought to be protective.
Red meat, and processed meats such as boerewors, are intrinsic to South African braai culture. The first time I heard at a guys-only braai that ‘chicken is a vegetable’, I laughed – it’s not so funny now, given South African men’s cancer stats.
SA also has one of the highest incidences in the world of lung cancer. UCT pulmonologist Dr Greg Symons explains that this is not just because of smoking, though that is the overwhelming reason. Other contributors are illegal drug use (including dagga and other inhalants); air pollution both outside and in the home, where the use of heating and cooking fuels together with inadequate ventilation is widespread; and workplace and industrial contamination, in mining and other industries.
SELF- CHECKS & SCREENING
When it comes to our most common cancers, there are several self-tests and routine screenings you can employ for early detection.
Skin check self-test. Starting at puberty, check your skin monthly for anomalies. Get to a doctor if you spot any sores that don’t heal; new or expanding moles or dark spots that don’t go away; or any mole that starts itching, bleeding or showing any sensation.
The moles don’t need to be big to be dangerous. As Dr Whitaker explains, a mole is harmless; but a melanoma only two millimetres thick will almost certainly kill you.
Testicular cancer screening self-test. Men, especially young men, should check their testicles monthly, during or after a warm bath or shower. Cup each testicle with a hand and roll it between thumb and fingers, feeling for lumps, irregularities or changes in size. Become familiar with your balls, including the spermatic cord and epididymis – the tube-like structures that connect to the back of each testicle. CANSA provides detailed info on how to self-test (www.cansa.org.za)
Prostate screening. Men over 50 – or, if at high risk, over 35 – should consider being screened annually for prostate cancer by means of a Prostate Specific
Antigen (PSA) blood test. PSA (a protein) level is routinely higher than normal in prostate cancer and other inflammatory prostate conditions. In addition to a PSA test, get a Digital Rectal Exam (DRE). Dr Wood says it’s important to get both tests, because the PSA test fails to detect the most aggressive kind of prostate cancer – about 5% of cases.
Colorectal cancer screening. At age 50 and annually thereafter, get a faecal occult blood test. This lab test is non-invasive, and examines a smear of faeces for blood that may suggest cancer or other problems. Your doctor, clinic or CANSA will offer it.
At age 50, or 10 years before the age a first-degree relative was diagnosed with colorectal cancer, and every 10 years thereafter, get a colonoscopy. This is a day procedure in which a gastroenterologist examines the colon with a scope for polyps, which he can remove for analysis and cancer prevention.
KNOW YOUR BODY; AND CHECK IN WITH IT REGULARLY
The main thing is to know your body, and see your doctor as soon as something different or abnormal appears. This goes for your skin, balls and penis, fatigue levels, weight, bowel and urination habits, and lung function. Be aware. Be curious. Check anything abnormal with a doctor.
Brett Simpson says his cancer diagnosis has made him more aware of his body. When he sees something suspicious, he waits no more than five days before he goes to the doctor, on an emergency basis, to get it checked. While he’s had some false scares, he’s also nipped another case of skin cancer in the bud.
REDUCING YOUR CANCER RISK – THE BASICS
Avoid the sun. Wear sun-protective clothing on arms and legs and a brimmed hat on your head – that’s the best protection. Use sunscreen of at least SPF 50+ on exposed skin, with full UVA protection, and don’t scrimp. Reapply at least every five hours; more often, if you sweat or get wet.
Don’t smoke. Smoking is linked with higher risk of many cancers – not just of the lungs, but mouth, throat, bladder and pancreatic cancer too. Ventilate adequately when using cooking or heating fuel. Avoid exposure to industrial pollutants, and use adequate protective equipment. Dr Symons says that despite manufacturers’ claims, there is no reliable evidence that e-cigarettes or other nicotine inhalants are safer than conventional cigarettes; it will take years to determine their safety. Exercise regularly and maintain a healthy weight. Internal cancers such as colorectal cancer and prostate
cancer are particularly associated with abdominal obesity. Dr Wood has noted this association in his practice – he sees more cancers in overweight men who don’t exercise than in thin, fit guys. Eat a healthy diet, and stock up on whole grains and
plants, including whole fruits and veg. It’s thought that fruits and veggies contain important nutrients and fibre that may prevent or slow the growth of cancers. Megan Kluyts, consulting dietician for CANSA, recommends that you aim to consume at least five servings of whole fruit and vegetables per day. Reduce the amount of red meat and processed meat
you eat. Both are directly associated with a higher risk of colorectal cancer. Avoid charred meat, and meat cooked at high temperatures.
Avoid or limit alcohol. The International Agency for Research on Cancer (IARC) has labelled alcohol a carcinogen. Any alcohol, regardless of type, increases your risk of cancer, including liver, colorectal, mouth, throat, stomach and oesophageal cancer. Professor Michael Herbst of CANSA points out that although many consider red wine healthy because of its (wildly touted) heart benefits, they are unaware of its link to cancer.
Age. For most cancers, risk increases with age. While you can’t change your age, you can get regular screenings or do self-checks, especially as you get older.
Family history of cancer. Again, you can’t change the facts – but you can be more vigilant. Your risk of getting cancer increases if a family member (especially a first-degree family member) has it. In the case of colorectal cancer, one close family member with the disease more than doubles your risk; two family members more than quadruple your risk.
Similarly, men have an increased risk of prostate cancer if they have a close relative with prostate or breast cancer. Wayne Herwitch got the PSA test he’d been putting off after his sister was diagnosed with inoperable neck cancer.
Bottom line? Share your health history with family members, and don’t be shy to ask about theirs.
BEING GOOD ISN’T ENOUGH
Lucy Balona reiterates that virtuous living and eliminating lifestyle risks can reduce cancer risk – but not eliminate it. “It’s essential that men go for routine screening and do regular self-checks,” she says, so that they can catch a cancer early. Once it grows or metastasizes, cancer is more difficult to treat or contain, if not impossible.
Moses, Mark, Wayne, Marc and Brett are all men who went for screening or took action when they saw signs of something amiss. And that’s why they’re still alive to tell you about the benefits of knowing your body, getting screened, and being in the driver’s seat when it comes to your health.